What´s new in PubMed this week
Riva FMG, Kerawala C. Perforator Flaps and Robotic Surgery for Head and Neck Reconstruction. Oral Maxillofac Surg Clin North Am. 2024 Aug 13:S1042-3699(24)00047-5. doi: 10.1016/j.coms.2024.07.006. Epub ahead of print. PMID: 39142950.
Minimally invasive robotic transoral approach for head and neck cancer has dramatically reduced the need for reconstruction, particularly for oropharyngeal cancer. Cancer of the oral cavity remains for indications, but it usually does not require robotic surgery. The workhorse of perforator free flaps in head and neck reconstruction in the anterolateral thigh (ALT), which is not a usual choice in this situation. Also, as we all know, robotic surgery is normally used in the resective time but not in the inset of the flap, which is better managed in a traditional fashion. At the end, the important issue is to avoid the mandibulotomy. However, an interesting case-series presentation.
Mandloi S, Garg N, Naimi B, Shah R, Kaki P, Alnemri A, Duffy A, Zhan T, Kaffenberger TM, Boon MS, Huntley CT. Transoral Robotic Surgery Versus Hypoglossal Nerve Stimulation for OSA: A Cost Analysis Study. Laryngoscope. 2024 Aug 13. doi: 10.1002/lary.31697. Epub ahead of print. PMID: 39136252.
Extremely interesting. A cost study. 395 patients: 375 UAS vs 20 TORS. Average total cost was significantly higher in the UAS group: UAS: $25,582.60; TORS: $5832.60; p < 0.001.
From a theoretical point of view indications differ. TORS is a resective procedure on the base of the tongue when there is an excess of tissue in the lingual tonsil. Upper Airway Stimulation in used to keep the tone in the genio-glossus muscle (you do not want to resect the genio-glossus). In real clinical situations indications overlap.
Virós Porcuna D, Pollán Guisasola CM, Viña Soria C, Vergés Fort P, Palau Viarnès M, Juesas Iglesias L, De Virgilio A. Transoral robotic parapharyngeal space dissection. Head Neck. 2024 Aug 12. doi: 10.1002/hed.27902. Epub ahead of print. PMID: 39132821.
David Viros has became a master of the TORS approach to the parapharyngeal space. Congrats again.
Chettuvatti K, Panda NK, Mittal A, Bakshi JB, Das A. Decoding the Enigma: Harnessing HPV Testing for the Precision Care in Carcinoma Unknown Primary with Secondary Metastasis to the Neck in North Indian Population Undergoing TORS for Primary Identification. Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3133-3139. doi: 10.1007/s12070-024-04628-5. Epub 2024 Mar 28. PMID: 39130254; PMCID: PMC11306854.
I am not sure I do understand this paper, except in the sense that India is still a low incidence region.
Chen J, Zhang X, Yan S, Li X, Li M, Zhang Y, Zhang S, Li F, Song M. Transoral Robotic Surgery and Human Papillomavirus Infection: Impact on Oropharyngeal Cancer Prognosis. J Clin Med. 2024 Jul 30;13(15):4455. doi: 10.3390/jcm13154455. PMID: 39124727; PMCID: PMC11313069.
China.
This is a free full text.
135 OPC patients treated with traditional surgery from 2008 to 2018 and 130 OPC patients treated with TORS from 2017 to 2021. They apparently do better with TORS…
J Granell. August 17, 2024.